Benjamin Elizabeth, Haltmeier Tobias, Chouliaras Konstantinos, Siboni Stefano, Durso Joseph, Inaba Kenji, Demetriades Demetrios
From the Division of Trauma and Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
J Trauma Acute Care Surg. 2015 Dec;79(6):1030-6; discussion 1036-7. doi: 10.1097/TA.0000000000000704.
Aspiration events (AEs) are a well-recognized complication in trauma patients and have traditionally been considered a risk factor for pneumonia. Despite this, there is no consensus on the incidence or clinical significance of AE in the trauma population.
All patients admitted as trauma team activations at our Level I trauma center who were intubated in the field or on arrival from September 2013 to August 2014 were prospectively collected. Field and admission data including witnessed AEs were analyzed. Additional hospital data included imaging, associated injuries, laboratory, and clinical data. Early respiratory failure, pneumonia, and hospital mortality were collected.
During the study period, 228 patients met inclusion criteria. Median age was 35.5 years, and Injury Severity Score (ISS) was 21.0. Overall, 58 patients (25.4%) had witnessed AEs. Patients with AE had significantly higher ISS (26.0 vs. 17.0, p = 0.027) and lower Glasgow Coma Scale (GCS) score on admission (median, 4.0 vs. 7.0; p = 0.003), despite similar field GCS score (p = 0.946). Body mass index (median, 27.2 vs. 26.2; p = 0.374) and intoxication rates (86.2% vs. 83.5%, p = 0.835) were similar between groups. Early pneumonia and respiratory failure were rare in all patients and were not higher in those with AE. Although mortality was higher after AE in patients who died directly after admission (51.7% vs. 30.0%, p = 0.004), in patients who survived to intensive care unit admission, there was no longer a difference between groups and aspiration was not an independent predictor of mortality (p = 0.107) on multivariable regression analysis.
The rate of aspiration in trauma is high and more likely to occur in patients with increased injury burden or depressed GCS score. In patients who survive past admission, early pneumonia rates are similar, regardless of AE. These data suggest that aspiration is a marker of severe illness and is associated with but not an independent predictor of mortality.
Prognostic/epidemiologic study, level III.
误吸事件（AEs）是创伤患者中一种公认的并发症，传统上被认为是肺炎的危险因素。尽管如此，关于创伤人群中误吸事件的发生率或临床意义尚无共识。
前瞻性收集了2013年9月至2014年8月期间在我们的一级创伤中心因创伤团队启动而入院、在现场或到达时接受插管的所有患者。分析了包括目击误吸事件在内的现场和入院数据。其他医院数据包括影像学、相关损伤、实验室和临床数据。收集早期呼吸衰竭、肺炎和医院死亡率。
在研究期间，228例患者符合纳入标准。中位年龄为35.5岁，损伤严重程度评分（ISS）为21.0。总体而言，58例患者（25.4%）发生了目击误吸事件。误吸事件患者的ISS显著更高（26.0对17.0，p = 0.027），入院时格拉斯哥昏迷量表（GCS）评分更低（中位数，4.0对7.0；p = 0.003），尽管现场GCS评分相似（p = 0.946）。两组间体重指数（中位数，27.2对26.2；p = 0.374）和中毒率（86.2%对83.5%，p = 0.835）相似。所有患者中早期肺炎和呼吸衰竭很少见，误吸事件患者中也不更高。尽管入院后直接死亡的患者中误吸事件后的死亡率更高（51.7%对30.0%，p = 0.004），但在存活至重症监护病房入院的患者中，两组间不再有差异，多变量回归分析显示误吸不是死亡率的独立预测因素（p = 0.107）。
创伤中误吸发生率很高，更易发生于损伤负担增加或GCS评分降低的患者。在入院后存活的患者中，无论是否发生误吸事件，早期肺炎发生率相似。这些数据表明误吸是重症的一个标志，与死亡率相关但不是死亡率的独立预测因素。
预后/流行病学研究，三级。
